USMLE Step 2 Clinical Skills

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Step 2 Clinical Skills (Step 2 CS) of the United States Medical Licensing Examination (USMLE) is an exam that is currently administered to medical students/graduates who wish to become licensed physicians in the U.S.[citation needed]. It is comparable to the COMLEX-USA Level 2-PE exam, taken by osteopathic medical students/graduates who seek licensure as physicians in the U.S.[1] From January 2011, the registration fee for the test is $1,355.[2] Historically, US students have taken Step 2 CS late in their senior year, prior to graduation. However, some residency programs (such as those at the University of California, San Francisco) now require students to record a passing score for both Step 2 CS and CK prior to February 15 of the application year.[3] This has led some US medical schools in 2009 and 2010 to begin recommending that students take Step 2 CS in the Fall of their senior year.


The USMLE Step 2CS exam consists of a series of patient encounters in which the examinees must see standardized patients (SPs), take a history, do a physical examination, determine differential diagnoses, and then write a patient note based on their determinations. The topics covered are common outpatient or Emergency Room visits which are encountered in the fields of internal medicine, surgery, psychiatry, pediatrics, and obstetrics and gynecology. Examinees are expected to investigate the simulated patient's chief complaint, as well as obtain a thorough assessment of their past medical history, medications, allergies, social history (including alcohol, tobacco, drug use, sexual practices, etc.), and family history. Usually, examinees have one telephone encounter, speaking to an SP through a microphone during which there is no physical exam component.

Examinees are allowed 15 minutes to complete each encounter and 10 minutes for the patient note for a single patient encounter. The patient note is slightly different from a standard SOAP note. For the exam note, the examinees will document the pertinent facts relating to the history of present illness as well as elements of the past medical history, medication history, allergies, social history, family history, and physical exam. The examinees will then state up to 3 differential diagnoses relating to the simulated patient's symptoms, and tests or procedures to investigate the simulated patient's complaints.[4] The examinees should also list pertinent positive and negative findings to support each potential diagnosis.[4] The examinees will not recommend any specific treatments in the note in contrast to a true clinic SOAP note (i.e., IV fluids, antibiotics, or other medications). Over the course of an 8-hour exam day, the examinees complete 12 such encounters. Step 2 CS examinees will be required to type patient notes on a computer beginning July 17, 2011.[5]

USMLE Step 2 CS replaced the former ECFMG Clinical Skills Assessment (CSA) effective June 14, 2004. The last administration of the ECFMG Clinical Skills Assessment (CSA) took place on April 16, 2004. When the CSA first started it was strictly for Foreign Medical Graduates while US graduates were not required to do it. That was considered double standards in the US medical licensing process. Later the CSA was replaced with the USMLE step 2 CS and became inclusive to all medical graduates.


The test is graded on a pass/fail basis, without any numerical score associated with it (as opposed to the other parts of the USMLE series). In order to pass, one must achieve a grade of "pass" in each of the three sub-components of the exam.[6] A score report is provided in the event of failure.

  • Integrated Clinical Encounter (ICE) - This component includes the ability of the examinees to collect pertinent clinical information from the SP, and to write an appropriate patient note with differential after the clinical encounter. The former part is graded by the simulated patient, and the latter by a practicing physician.
  • Communication and Interpersonal Skills (CIS) - This component includes evaluating the examinees' question asking skills (asking open ended questions, avoiding repetition and medical jargon), information sharing skills (acknowledging patient concerns, providing counseling and information about what will happen in the future), and professionalism / rapport (asking about feelings and concerns, showing consideration for patient comfort, proper hygiene during examinations, providing empathy and respect for the simulated patient).
  • Spoken English Proficiency (SEP) - This component includes clarity of spoken English communication in the context of pronunciation, word choice, and minimizing the need to repeat questions or statements.

Exam centers[edit]

This exam can be taken only in the USA at five Clinical Skills Evaluation Centers (CSEC), located in:

See also[edit]


External links[edit]